Sleeveless T-shirt in 35*F

So yesterday, Thursday 3/12 was a nice day. It started off with a standardized patient encounter at 9:30a. Even though it was scheduled to start at 9:15a, no big deal.
What's standardized patient (SP) encounter?- some of you migt wonder
It is when someone is acting as a patient. That is they present with a complain and have a script which they follow. This is used as a teaching tool so that medical students can act as doctors and attend to the SP's complaints, do physical exam then come up with an assessment and plan on how to treat the patient (SP). My first SP presented with a neurological complain and the second one presented with some generalized complain (realize that I'm trying not to be specific here b/c we're not allow to talk about specifics of the encounter) so I apologize if I'm not being clear enough or at all. Then I returned home which is about 10 minutes walk from the hospital. Ate some lunch then drove to the Family Medicince clinic.

I saw this 39y/o African American (AA) . Upon entering the exam room, I saw a gentleman, unkempt wearing a sleeveless t-shirt, sitting down while shaking both legs which were crossed at the ankle. During part of our conversation, he told me that he had a chronic flank pain (pain around the R mid back region) due to kidney stones and was on Percocet (a narcotic). He wanted a refill of his narcotic. I wanted to assess how well the Narcotic is working and how to adjust (if necessary). He proceeded to tel me that he used to take Oxycontin (a Narcotic) and was changed a couple of months ago to Percocet. "Dem Percs sure work like magic doc. They must hae some enzyme or something. Ever since I been taking dem, my stones are coming out in tiny pieces and not as big as they used to be when I was on Oxy's).

It's also amazing how many people will come to the doctor with diagnosis already and just wanting to get some Antibiotics for their self made diagnosis. I'm all about empowering the patient but I think the patient should have an open mind and let the doctor explain his thought process ... at least a doctor has spent a lot of years in school learning about all these things.

Later.

doctoring

Another interesting day at the Family Medicine clinic. In all honesty, I'm having more fun that I thought I will. Learning fast and my preceptor, Dr. Evans is GREAT!!! I did a presentation on Hyperparathyroidism today and I think I did fine.

So I was seeing this mid age AA female who came in with periorbital edema and erythema. She asked if she could get a tetanus vaccine, she has had the last short over 10yrs ago. Sure you can. Why are you asking for a tetanus shot? I asked. "It's because of my allergies. I need it for my allergies".

I'll be having a standardized patient tomorrow and I'm about ready for that. Will see how it goes!

Will keep you posted!

A boy or a girl? that's the question.

So today was another fast pace day at the Family Medicine clinic in Baltimore, at Edmodson where I'm currently doing my rotations. Here are a couple of things that are worth remembering from my day.

Went into the room to see a 1y/o male who was accompanied by his mom. He had his hair plaited in corn rows. My first statement after I introduced myself was ... I'm going to talk to you and examine her then ... before I could finish, I was interrupted by mom who said "you mean see him?" I'm so very sorry, I mean him; I replied. That kid totally looked like a girl compounded with the fact that he had corn rows.

So I was seeing a 62y/o female with history of COPD who was discharged 4ds ago from the hospital following a 10day hospitalization secondary to pneumonia. On reviewing her social history: Do you smoke or have you ever smoked? "I quit already" she said. OK, congratulations that good! When was the last time you smoked a cigarette? "3days ago. But I quit because I was told at the hospital that if I smoke again I will die. So I didn't smoke while at the hospital but I had to smoke when I got home on the first day because I just couldn't quit like that"

Was seeing an 80y/o female with history of HTN. On reviewing his diet: Do you watch your salt or sodium intake? "Yes, I usually have to boil my hotdog twice in 2 different water in order to get rid of the salt in it"

"Peotry of life"

The director of Family medicine clerkship at my school, Dr. Colgan, is a great clinician. In my opinion, one of the finest teachers of medicine. He teaches with passion, you can feel it sitting across the room from him. During today's lectures, he encouraged us to collect interesting quotes from our patients as something to look back on some years from now. I thought it was a great idea but decided to take it a step further: I'll be collecting quotes from both patients, colleagues and doctors.

The first one happens to come from a doctor. "You're still people but you're dangerousely close to becoming doctors" Dr Ferentz on supplements and vitamins and how doctors should advise their patients on not taking them because they're worthless.

"Sir, you must be very smart" a caretaker accompanying a mentally challenged pt mumbled to me. Why do you say that, I asked. "Because many young foreigners come to this country [US] and don't really do anything with their lifes, like my mom's husband" replied the caretaker. Little did she know that I was in her exact same position about 8yrs ago.

"What's your name again?" a pt asked. "Anselm" was my reply. "Ohh Handsome! I bet you must be getting in a lot of trouble with that name don't you?" pt replied. This same patient tells the doctor "only the 'dine works for my blood pressure. I done try all the other stuff ... the HCZ or whatever and dem, I done try them. I'm telling you ...." Pt w/ h/o drug abuse wants only Clonidine ('dine) for control of his HTN.

"... and there's a hole in the back of my throat. Do you think them cold drops could have caused that?" the patient asked. Wait huh?, I thought to myself. How many cough drops do you take? "I've taken as much as 380 in a day. You know I don't suck on them, I just crunch them with my teeth. They go just like that. I'm addicted to them ... do y'all have some cough drops around here?" I'm sorry, we don't.

After an otoscopic exam a pt, who came in w/ cold symptoms, asks me "do you see that I'm dehydrated?"

While taking a sexual history a 21y/o female pt says; "you be sitting there and hearing all these things but acting all professional, even though you young ..."

Mr. L, your BP still looks high today. Talking to a pt who does NOT want to be started on anti-hypertensives "...well it's probably 'cause I had some canned soup for lunch and used nasonex this morning ..."

To be continued...